According to National Health and Safety Executive figures, musculoskeletal disorders accounted for 6.9 million days lost last year. Whilst these are shocking stats, they don’t really surprise me as a high number of people who attend my classes come with back issues. Some people have had a diagnosis but, the vast majority complain of niggles, tightness or discomfort in their back. That’s not to minimise their discomfort but simply that there’s no identifiable trauma or injury which has aggravated the problem.
According to physical therapist Bill Reif, author of the book The Back Pain Secret: The Real Cause of Women’s Back Pain and How to Treat It, those with back issues who’ve received permission from their doctors to practice yoga may find it to be a boon.
Reif says, “Yoga, like physical therapy, could help build core strength and improve control of the spinal curvatures, minimizing the effects of compression.” But he offers this caveat: “Yoga may be appropriate for those with mild, intermittent, or occasional symptoms. Those with moderate to severe problems with frequent pain may not be able to tolerate most active forms of yoga, and should probably seek out a more restorative practice that uses props to help maintain neutral spinal curvature.”
For most people, yoga is an affordable and enjoyable way to manage their back condition but, in order to ensure that the practice doesn’t exacerbate the problem, here are a few top tips to bear in mind.
Don’t lose your natural lumbar curve. Slumping, or rounding the spine, perhaps because of spending long hours in an office chair that encourages bad posture, can take a toll on the back. In most yoga poses and throughout your day, whether sitting or standing, it’s important to maintain the natural inward curve in your lower back, to keep the back of your head lined up with the back of your pelvis (not dropping the head forward or back), and to keep your shoulders broad and stacked right over your hips. Even though your yoga teacher may cue a “flat back” (often to prevent you from losing your natural spinal curves by rounding or overarching the back), a totally flat back is not what we’re looking for. The spine’s natural curves—a slight inward curve of the lumbar spine (lower back), a slight outward curve of the thoracic spine (upper/middle back), and a slight inward curve of the cervical spine (neck)—are important for shock absorption and for optimal spinal health, so we don’t want them to go away!
Do practice healthier sitting and standing postures to help strengthen the back. Practice sitting tall, either in a chair or on the floor using props such as a stack of folded blankets or a yoga bolster while being mindful of maintaining the natural curve of your lumbar spine. Use this new posture any time you sit. When sitting or standing, utilize core support, with a slight lift of the lower abdominals and pelvic floor, and “think tall” with axial extension (upward lift) of the spine.
Don’t let the feet turn out when standing or walking. For many people, external rotation of the feet is both a result and a cause of shortening the piriformis (a culprit in sciatica). When this deep hip rotator is tight, the psoas (which runs from the lumbar spine to the top of the thigh) can also become tight, possibly resulting in lower back pain.
To help stretch a tight piriformis, practice supine pigeon pose, lying on your back and hugging one knee toward the center of your chest, or a figure-4 stretch, lying on your back and crossing one ankle over the thigh of the bent opposite leg. For a tight psoas, a supported bridge pose with a yoga block under your pelvis and a high or low lunge(anjaneyasana) practiced with a slight anterior (forward) tilt of the pelvis can help.
Do keep the feet parallel. If your toes tend to turn out, move your heels out enough so that they’re behind your toes. You want the second toes of each foot to be relatively parallel to each other and your knees tracking in line with the center of the foot. Do this when standing (whether in mountain pose, while working at a standing desk, or any other time), walking, or sitting.
(Note that while parallel feet is a good guideline for most people, it won’t be appropriate for everyone. See Bernie Clark’s article Should Your Feet Be Parallel in Mountain Pose and Down Dog? to learn more.)
Don’t round up from a standing forward fold with straight legs. This action can compress the discs of the anterior spine and aggravate back pain.Instead, to come out of a standing forward fold, keep your knees bent, walk your hands up your thighs, and keep your spine long as you rise to standing.
Do rise up from a forward fold with knees slightly bent, and use core support (a slight engagement of the pelvic floor and lower belly) as you lift your torso.
Don’t forget core strength. Yoga sequences often focus more on stretch than on strength. Stretching can be great for alleviating tightness in back muscles, and poses we might associate with a nice back stretch such as marjaryasana (cat-cow), balasana (child pose), ananda balasana (happy baby), and supine twists may feel good, but they don’t contribute much to building core strength, which is important for back health. To strengthen the back of a structure we must balance the support in the front. That’s why poses that incorporate abdominal and back strength are important for back health.
You can build abdominal strength with postures like paripurna navasana (boat), utkatasana (chair), plank and forearm plank, and vasisthasana (side plank), and back strength with postures like salabhasana (locust) and virabhadrasana III (warrior III). Strengthening abdominal and back muscles supports better spinal alignment, and these are the types of poses you might look for in a back-health-focused yoga class.
Caring for your back means developing healthy postural and movement habits and practicing postures and exercises that can build the muscle strength that will give your spine the support it needs. Now medical professionals are even beginning to recommend these methods over medication for the treatment of temporary or chronic low back pain, so if you suffer from back pain try putting down the pills (with your doctor’s OK), sitting up straight, moving about with more awareness, and hitting the mat for a strength-building, tension-busting yoga session to subdue that troublesome ache and find the joys of unimpaired motion once again.
Don’t practice full inversions.
“Any inversion compresses the lumbar spine because of the additional body weight from above, potentially further narrowing the space through which the nerves must pass freely,” Reif says. “Additionally, inversions may make it more difficult to maintain a neutral spine for some individuals.”
Headstand, shoulderstand, forearm balance, and handstand should all be avoided unless a student is a longtime practitioner who can maintain a neutral spine in these inversions and can maintain control as they come into and out of the pose. Try milder inversions like downward facing dog and legs up the wall instead.
Do avoid deep backbends
“Lumbar extension, which can close off the spinal canal, is unlikely to feel good to those with lumbar issues,” Reif says.
He recommends avoiding backbends like upward dog, wheel, locust, and camel. Milder backbends, like sphinx and bridge, in which the arms can be used to channel the backbend only into the mid and upper back, may be suitable for some with LSS as long as they don’t lead to any increase in symptoms.
3. Don’t twist to an extreme and/or with a rounded back if it doesn’t feel good.
“Twisting can often lead to or exacerbate symptoms,” Reif says. Twists like deep versions of janu sirsasana (head to knee pose), revolved chair pose, and others that involve a rounding of the lower back could place uncomfortable pressure on the lower back, and should be avoided if they make any symptoms worse.
Reif does acknowledge that some measure of twisting may be accessible for those with mild stenosis.
“I would encourage only the twists that allow a neutral lumbar spine,” Reif says. He recommends “thread the needle twist” (sometimes called parivrtta balasana, revolved child’s pose) from hands and knees, and windshield wipering the legs.” Warriors I and II also involve minor twists that may be tolerable for many of those with spinal problems.
Those with more severe symptoms may be better off finding only the barest hint of a twist or may be able to twist only to one side: If the problem occurs along the right side of the spine, rotating to the left may decompress the compressed area, whereas twisting to the right, toward the compressed area, could increase symptoms. Skip twisting to one side if it causes pain.
Do avoid or modify deep side bends if they worsen symptoms.
A modest amount of side bending can strengthen and even decompress the spine, but, “Again, an extreme of range will possibly exacerbate symptoms,” Reif says. As is the case with twisting, side bend only to the extent that feels good, and if side bending to one side feels compressive, skip it.
In poses like gate pose or a standing side bend, stay as high as you need to in order to be comfortable.
In Daily Life
In addition to following the do’s and don’ts that make sense to you, as often as possible, return to the self-awareness you’ve cultivated through your mindful yoga practice: Notice how the activities of your daily life affect how you feel. Which activities seem helpful? Which less so?
If some activities aggravate your symptoms, could you change the way you do them, repositioning your body to take stress off your lower back, or taking breaks to sit down and lean forward, elbows on thighs? Or perhaps you could approach those movements with more breath, or less hurry?
You may find that devoting some attention to your spinal well-being throughout your day—and night—gradually becomes easier, as do your movements themselves.